…93%) for myocardial infarction. Moreover, fragmented QRS is associated with an increased risk of sudden cardiac death and ventricular arrhythmias. Figure 2. Fragmented QRS complex…

…phenotype later and require delayed or individualized assessment. Disease specific genetic architecture HCM is predominantly associated with variants affecting sarcomeric proteins, particularly MYH7 and MYBPC3…

…used. Risk in these circumstances appears to track more closely with apoB. Discordantly high apoB is especially associated with metabolic syndrome and mildly elevated triglycerides…

…in the US and many other countries, a 2:1 block will be difficult to discern because the flutter wave may fuse with the preceding…

…Consequently, the decision to prescribe colchicine requires attention to the balance between reduction in ischaemic events and possible infectious or other non cardiovascular adverse outcomes…

…to reduce recurrent myocardial infarction, stent thrombosis and other ischemic events after coronary angiography, percutaneous coronary intervention (PCI), or medical management. The standard post ACS…

…Caffeine and other methylxanthines, which antagonize adenosine receptors, should be avoided for at least 12 hours before testing. Dobutamine : Contraindicated in patients with severe hypertension…

…bundle branch block in acute anterior infarction, and before drugs or procedures with a known risk of bradycardia. Transvenous pacing is chosen when the need…

…myocardial oxygen consumption associated with exercise. Chronic myocardial injury Long term heavy consumption can produce a cardiomyopathy, although the exact exposure threshold and duration required…

…The European definition uses BP ≥180/110 mmHg with acute HMOD, although other guidance emphasizes that no single BP threshold is diagnostically sufficient: the presence…

…barriers associated with more frequent injectable therapy, although the clinical importance of improved adherence remains dependent on sustained follow up and administration. Clinical indications and…

…ECG has low sensitivity with respect to detecting biventricular hypertrophy. This is because the strong and oppositely directed forces tend to cancel each other out…

…Management and treatment of AV blocks (AV block 1, 2 & 3) Evaluation of patients with suspected AV blocks requires a thorough medical history (with emphasis…

…Table 1: Myocardial and ECG reaction in various settings with ischemia or increased workload STATUS OF CORONARY ARTERY SETTING EFFECT ECG REACTION Normal coronary artery…

…and progress in our understanding of the pathophysiology of cardiac disease. Ultrasound systems have become cheaper, more portable, more powerful, equipped with an increasing number…

…the sinoatrial node. They may also induce conduction defects (e.g. AV block). Increased intracranial pressure (manifests with sinus bradycardia and hypertension). Hypothyroidism . Hypothermia . Hyperkalemia …

…be seen. This is pathognomonic (unique) to ventricular fibrillation and must not be confused with any other arrhythmia. Figure 1. Ventricular fibrillation and asystole. ECG…

… inspection of the legs and feet. A systolic blood pressure difference between the arms exceeding 15 mmHg is associated with a 50% higher risk of…

…Associated With Dietary Patterns Cardiovascular disease and mortality The strongest long term evidence supports Mediterranean or DASH style patterns that emphasize minimally processed foods and…

…intraluminal mass and lesion haziness raise suspicion of thrombus, although haziness is not specific. Intravascular imaging can identify plaque disruption, thrombus and other structural features…

…zone (the outermost and less ischemic area), which may receive oxygen from collateral vessels. In cardiac arrest, there is no cerebral perfusion, with an equal…

…coronary, cerebrovascular or other peripheral arterial disease, and management should therefore address the entire arterial circulation. PAD is associated with increased cardiovascular morbidity and mortality…

…not the skin. Aspiration needle (iliac crest or sternal needle with stylet) and a Jamshidi type biopsy needle. Syringes: a small 5–10 mL syringe…

…canal is characterised by: A latency of 1–5 seconds before the nystagmus begins. Upbeating and rotatory (torsional) nystagmus with the fast phase beating towards

…score. Comparison with other bleeding risk models Several bleeding risk assessment tools exist for patients with AF, including HAS BLED, HEMORR2HAGES, and ORBIT scores. Each…

…that interacts with G protein coupled A1 receptors located on the extracellular surface of cardiac cells. Through the guanine nucleotide regulatory proteins Gi and Go…

…in the early hours following infarction may be associated with hemodynamic compromise. More broadly, bradyarrhythmic arrest and asystole represent severe manifestations of impulse generation or…

…cardiovascular risk varies considerably according to age and the presence of concomitant risk factors. In contrast, patients with confirmed hypertension generally require BP lowering treatment…

…and blood transfusion with radial access. Radial access has also been associated with lower overall major adverse cardiac events and mortality in pooled analyses of…

…associated with exertional angina, myocardial ischaemia, myocardial infarction, ventricular arrhythmias, impaired left ventricular function, myocardial stunning, and sudden cardiac death. It may also be associated…

…and necrotic components. Virtual histology IVUS has also been used to identify thin cap fibroatheroma, a plaque phenotype associated with subsequent major adverse cardiovascular events…

…younger and more often female than patients with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional…

…procedures overall. It is particularly associated with intervention on degenerated saphenous vein grafts (SVGs), rotational atherectomy, and procedures performed for acute myocardial infarction. In SVG…

…mortality; and A higher probability of secondary hypertension. Patients may also have comorbid features associated with a greater cardiovascular risk among those with resistant hypertension…

…Patients with acute coronary syndrome should be offered cessation support during hospitalization. Depression and adverse environmental exposures are associated with continued or resumed smoking after…

…Other mechanisms capable of obstructing coronary arteries include embolism, dissection, coronary arteritis associated with systemic vasculitis, extrinsic compression, myocardial bridging and radiation induced coronary disease…

…nearly empty). In patients with an initial shockable rhythm, compressions and ventilation can extend the duration of the shockable rhythm by several minutes, allowing for…

…than 12 genetic mutations have been associated with the Brugada syndrome. These mutations are located in genes encoding potassium and calcium channels of the outer…

…by DeBehnke et al. and Safar et al. The majority of all asphytic cardiac arrests begin with PEA and progress to asystole. Shockable rhythms (ventricular…

…bundle of His, and hence it originates in the atria. In other words: tachycardias with narrow QRS complexes originate in the atria. the term supraventricular…

…on leads with opposite angle of observation. Other vectors may interfere with the injury currents, and inhibit them from being detected by leads with opposite…

…wide with discordant ST T segment and the rhythm is regular (in most cases). Idioventricular rhythm starts and terminates gradually. It occurs in other situations…

…NSTEMI and unstable angina. Management begins in parallel with the diagnostic work up. Obtain an interpretable 12 lead ECG within 10 minutes of first medical…

…cessation of prolonged and heavy alcohol intake. The condition can develop despite a measurable or high blood alcohol concentration, particularly in patients with marked tolerance…

…medical emergency. Evaluation and Physical Examination The evaluation of chronic cough in a patient taking an ACE inhibitor should begin with a comprehensive history and…

…haemodynamic collapse, and death. The clinical consequences are particularly important when pulmonary vascular obstruction is accompanied by limited cardiopulmonary reserve or other adverse comorbidity. The…

…is often more rapidly reversible than that of other forms of acute tubular necrosis, although the complication remains associated with post procedural morbidity and mortality…

…Factors associated with restenosis The risk of restenosis after metallic stent implantation is increased by: Small reference vessel size A small post procedural luminal diameter…

…The result should be integrated with the history, examination, ECG, echocardiography, and other relevant investigations. Clinical Presentation and Symptoms Natriuretic peptide testing is particularly useful…

…and other familial forms associated with adrenal adenoma or bilateral adrenal hyperplasia. A family history is therefore important, particularly in patients with early onset hypertension…

…precipitants include vigorous physical activity, emotional stress, and an intercurrent medical or surgical illness. Events may occur at any time, although clustering in the morning…

…syndromes and acute coronary syndromes HF across the spectrum of left ventricular ejection fraction AF and other arrhythmias Ischaemic stroke PAD CKD with associated cardiovascular…

…for conducting the test. All personnel must be appropriately trained and the laboratory must be equipped with defibrillators and other emergency instruments. Personnel conducting the…

…ventricular tachycardia, and other tachyarrhythmias with discernible QRS complexes. Shockable rhythm : Tachyarrhythmias that can be treated with defibrillation (ventricular fibrillation) or cardioversion (ventricular tachycardia). Non…

…rather than the emergency room: a very large or deep abscess, a markedly unwell patient with fever and systemic upset, suspected necrotising soft tissue infection…

…The local stroke protocol and immediate contact with the on call stroke consultant or the thrombectomy centre take precedence where there is a discrepancy or…

…the adverse effects and the important precautions. A hypertensive emergency is defined by a markedly raised blood pressure in combination with new or progressive acute…

…arrhythmias, and heart failure are among the conditions associated with myocardial injury. Relationship to chronic coronary syndromes Chronic coronary syndromes (CCS) describe stable period clinical…

…vulnerability to adverse outcomes. It is dynamic and may improve or worsen with illness, treatment, or other interventions. Frailty commonly overlaps with multimorbidity and is…

…and much earlier, more severe clinical disease. HeFH affects approximately 1 in 250–300 people and is the most common inherited metabolic disorder associated with…